ABSTRACT
BACKGROUND: The treatment of leprosy reactions (LRs) involves thalidomide, corticosteroids, and other immunomodulatory medications. This study evaluated the effect of these treatments on the association between periodontitis and LRs, as well as factors associated with LRs. METHODS: This case-control study was conducted on 283 individuals followed at a leprosy outpatient clinic in Brazil. The case group was comprised of 158 individuals presenting type 1 or type 2 LRs, and the control group of 125 leprosy individuals without reactions. A complete oral examination was performed to diagnose periodontitis, the independent variable. Antireaction medication used was collected from medical records, and participants were classified according to the use of prednisone and/or thalidomide, time of use, or non-use of medication. Socioeconomic-demographic, clinical, and lifestyle covariables were collected by interview. Unconditional logistic regression analysis by subgroups evaluated the effect of antireaction medication on the association between periodontitis and LRs, estimating the odds ratio with a 95% confidence interval (OR; 95% CI). RESULTS: A relationship between periodontitis and LRs was observed only in the subgroup using the association prednisone and thalidomide: ORadjusted = 0.32; 95% CI = 0.11-0.95. Conversely, more severe periodontal clinical parameters were observed in cases versus controls. Several socioeconomic, health conditions, and lifestyle factors were associated with the presence of LRs. CONCLUSIONS: Although periodontal disease indicators were worse among the cases, the findings showed a negative relationship between periodontitis and LRs in individuals receiving associated prednisone and thalidomide. These medications appear to influence the inflammatory cascade between diseases, modifying and masking the manifestations of periodontitis.
ABSTRACT
Diversos estudos têm sido desenvolvidos nos últimos anos avaliando o benefício do uso de antibioticoterapia sistêmica no tratamento das doenças periodontais. Contudo, a sua indicação deve ser restrita aos casos em que a terapia de remoção da causa primária e/ou a resposta imune do indivíduo não sejam capazes de debelar a infecção, ou quando houver envolvimento sistêmico. A indústria farmacêutica hoje dispõe de um considerável número de antibióticos acessíveis ao uso clínico, o que pode gerar dúvidas quanto a melhor indicação, prescrição e administração desses fármacos no tratamento das morbidades periodontais em que a sua utilização se faz justificável. Adicionalmente, as divergências metodológicas presentes nos estudos não permitem a obtenção de evidências que norteiem fidedignamente a prática clínica. Por outro lado, é importante considerar os eventuais riscos de toxicidade inerentes a cada droga e a possibilidade de resistência dos patógenos aos fármacos utilizados, o que se constitui em importante fator complicador do tratamento. Por esta razão, o objetivo deste artigo foi, por meio de uma revisão crítica e discutida da literatura, mostrar as atuais diretrizes do uso de antibióticos sistêmicos em Periodontia, com enfoque na indicação destes medicamentos, no tipo prescrito para cada caso e na duração do tratamento.
Several studies have been developed in recent years evaluating the benefit of the use of systemic antibiotics in the treatment of periodontal diseases. However, the indication should be restricted to cases where the therapy of removal of the primary cause and/or the immune response of an individual cannot overcome the infection or when there is a systemic involvement. The pharmaceutical industry today has a considerable number of antibiotics available for clinical use, which may raise doubts about the best indication, prescription and administration of these drugs in the treatment of periodontal diseases once their use can be justified. In addiction, the present methodological differences in the studies do not allow the achievement of evidences that can guide the clinical practice faithfully. On the other hand, it is also important to consider the possible risks inherent to the toxicity of each drug and the possibility of resistance of pathogens to the drugs used, which consists of an important complicating factor in the treatment. Thus, the aim of this study was to perform a critical review of the literature in order to indicate the current guidelines for the use of systemic antibiotics in periodontics, focusing on the indication of these medicines, on the type prescribed for each case and the duration of the treatment.
